Announcement. Mandatory health insurance V Russian Federation in 2020. Design features and necessary knowledge.

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Many citizens have already appreciated the value of compulsory health insurance. That is why he does not save on his health and actively pays for the pole.

So what is compulsory health insurance in Russia? And what are the main nuances of this procedure?

What you need to know

In accordance with the law, all citizens included in the system have the right to receive free medical care throughout the Russian Federation.

How the fund is organized and financed

The Compulsory Medical Insurance Fund is an independent state credit company that implements government policy in the medical industry.

Such organizations are designed to accumulate insurance premiums, as well as ensure financial stability.

This is already regulated by an additional agreement on the part of the medical institution and the applicant.

The clauses of the contract must include:

• date of conclusion;
• name of the insurer;
• basis for activity;
• subject of the contract;
• volume of medical care;
• date and signature.

Required documents

To register you will need:

• passport of a Russian citizen;
• birth certificate if it is a minor citizen;
• application of the established form.

For refugees, you must additionally provide a certificate of recognition as such. The foreigner must provide a residence permit or passport.

Stateless persons must provide registration and passport details.

Calculation procedure

How to calculate compulsory health insurance, according to the Federal Law, payment medical care carried out after the medical organization provides a register of accounts and an invoice for payment within the established limit.

Insurance Company:

• submits an application to the territorial body to receive a target remuneration for an advance payment;
• submits an application to receive an amount for services rendered.

Then the territorial authority reviews the application and satisfies it, transferring the required amount.

Details about insurance premiums for compulsory health insurance (CHI)

The duration of the billing period is determined for each year of time worked. This is exactly how accounting works.

The duration of the service is the entire life of the insured person. The payer of insurance premiums is an individual or an employer.

If a person is not employed, then he can independently contribute cash in the FSS. Insurance premiums are credited to the federal fund.

GARANT'S comment

See graphic copy of official publication

Federal Law of November 29, 2010 N 326-FZ “On Compulsory Health Insurance in the Russian Federation” (as amended on June 14, November 30, December 3, 2011)

GARANT'S comment

Cm. comments to this Federal Law

Chapter 1. General provisions

Article 1. Subject of regulation of this Federal Law

This Federal Law regulates relations arising in connection with the implementation of compulsory health insurance, including determining the legal status of subjects of compulsory health insurance and participants of compulsory health insurance, the grounds for the emergence of their rights and obligations, guarantees for their implementation, relations and responsibilities associated with the payment of insurance contributions for the non-working population.

GARANT'S comment

Cm. comments to Article 1 of this Federal Law

Article 2. Legal basis of compulsory health insurance

1. Legislation on compulsory health insurance is based on Constitution Russian Federation and consists of Fundamentals of legislation Russian Federation on protecting the health of citizens, Federal Law dated July 16, 1999 N 165-FZ “On the fundamentals of compulsory social insurance”, this Federal Law, other federal laws, laws of the constituent entities of the Russian Federation. Relations related to compulsory medical insurance are also regulated by other regulatory legal acts of the Russian Federation, other regulatory legal acts subjects of the Russian Federation.

GARANT'S comment

Cm. the federal law dated November 21, 2011 N 323-FZ "On the fundamentals of protecting the health of citizens in the Russian Federation"

2. If an international treaty of the Russian Federation establishes rules other than those provided for by this Federal Law, the rules of the international treaty of the Russian Federation apply.

3. For the purpose of uniform application of this Federal Law, if necessary, appropriate clarifications may be issued in ok established by the Government of the Russian Federation.

GARANT'S comment

Cm. comments to Article 2 of this Federal Law

Article 3. Basic concepts used in this Federal Law

For the purposes of this Federal Law, the following basic concepts are used:

1)compulsory health insurance- a type of compulsory social insurance, which is a system of legal, economic and organizational measures created by the state aimed at ensuring, upon the occurrence of an insured event, guarantees of free provision of medical care to the insured person at the expense of compulsory health insurance funds within the territorial program of compulsory health insurance and as established by this Federal by law in cases within the framework of the basic compulsory health insurance program;

2)object of compulsory health insurance-insurance risk associated with the emergence insured event;

3)insurance risk- an expected event, upon the occurrence of which there is a need to incur expenses to pay for the medical care provided to the insured person;

4)insurance case- an event that has occurred (illness, injury, other state of health of the insured person, preventive measures), upon the occurrence of which the insured person is provided with insurance coverage for compulsory medical insurance;

5)insurance coverage for compulsory medical insurance(hereinafter referred to as insurance coverage) - fulfillment of obligations to provide the insured person with the necessary medical care upon the occurrence of an insured event and to pay for it to the medical organization;

6)insurance premiums for compulsory health insurance- mandatory payments paid by policyholders are impersonal in nature and the purpose of which is to ensure the rights of the insured person to receive insurance coverage;

7)insured person- an individual who is subject to compulsory health insurance in accordance with this Federal Law;

8)basic compulsory health insurance program- an integral part of the program of state guarantees for the free provision of medical care to citizens, which determines the rights of insured persons to receive free medical care at the expense of compulsory health insurance throughout the Russian Federation and establishes uniform requirements for territorial compulsory health insurance programs;

9)territorial compulsory health insurance program- an integral part of the territorial program of state guarantees of free medical care to citizens, which determines the rights of insured persons to provide free medical care on the territory of a constituent entity of the Russian Federation and meets the uniform requirements of the basic compulsory health insurance program.

345 10/16/2019 8 min.

Russian legislation provides for the implementation of certain measures social protection citizens in order to protect their health. Such measures are manifested, including in health insurance. According to Federal Law of the Russian Federation 326, it is mandatory for all citizens. Based on it, each insured person can count on receiving the necessary medical care when certain circumstances occur. This assistance will be paid for from the insurer's funds.

General provisions of the Federal Law of the Russian Federation on Compulsory Medical Insurance

This federal law (FL) is based on the imperative provisions of the main law of the country, the Constitution, and cannot contradict them. The basic concept (OSHI) is understood as one of the types of insurance relations aimed at providing free medical care to insured citizens of the country in the event of certain insured events that are regulated by this law.

The object in these legal relations is the risk of the occurrence of these insured events, which is understood as a possible event, the occurrence of which creates the need to compensate for the costs of providing medical care.

The event itself is considered an insured event, in which medical care is directly provided and costs are compensated for it. Such cases are provided only for individuals who are insured. All these definitions are specified in Article 3 of this law.

And Article 4 regulates the basic principles of this insurance system. These include:

1. Providing guarantees for the provision of free medical care.
2. Mandatory payment of insurance premiums for policyholders.
3. Guarantees of financial stability of the formed system.
4. Respect for the rights of all participants in these legal relations.
5. Parity in all subjects in the management bodies of the insurance system.
6. Creation good conditions and quality medicine.

Based on these principles, the current insurance system has been formed, providing free medical care to insured citizens.

The Russian Federation, its subjects and bodies are responsible for the development of the legislative framework and their implementation. state power federal and local levels. Their powers are described in detail in Chapter 2 of this law.

Participants in legal relations

In these insurance relations, Article 9 of this legislative act identifies 3 types of entities:

• policyholders;
• insured citizens;
• Federal Fund.

In addition, participants in these legal relations are also various medical organizations that provide medical care to insured citizens.

This also includes medical insurance organizations and territorial funds of the constituent entities of the Russian Federation.

The following people can be insured persons:

• citizens of the Russian Federation;
• Foreign citizens;
• stateless persons.

But under the obligatory condition that they fit into one of the following categories:

• work officially according to employment contract;
• provide themselves with work and are registered in the prescribed manner;
• members of peasant farms;
• peoples of the Far North;
• minor children;
• pensioners;
• persons studying full-time;
• unemployed citizens registered at the labor exchange;
• other persons not working under an employment contract;
• parent caring for a child under 3 years of age;
• citizens caring for or elderly people.

These categories of citizens are subject to compulsory insurance and have the right to receive free medical care if they have proof of their status as an insured person.

Article 11 of this law defines the list of insurers who are obliged to insure citizens and pay insurance premiums for them in accordance with this legislation. These include:

• all legal and individuals who legally pay wages and other benefits to citizens;
• persons engaged in private practice;
• regional executive authorities authorized by this legislation.

According to Article 12, the insurer is determined to be the Federal Fund, which operates within the established limits basic program. This body has additional territorial funds. They are created by constituent entities of the Russian Federation in order to exercise the powers of the insurer in a given region.

Based on Article 13, territorial funds can create their branches and representative offices to exercise their powers.

In addition, medical insurance organizations have been created that enter into contracts with citizens. These organizations are required to obtain a license to carry out their activities. In addition to compulsory health insurance, these organizations do not have the right to engage in other types of activities.

Funds associated with compulsory insurance have separate accounting that does not overlap with voluntary insurance funds. Data legal entities are liable for their obligations by these means. Such insurance companies are required to publish all information about their financial activities on the Internet and in the media.

All such organizations are included in the register. Inclusion and exclusion from this register is carried out through notifications sent by the territorial Fund.

Another participant in these legal relations are medical organizations that directly provide medical care to citizens. To do this, they must also have the appropriate license and must be included in the register of medical organizations. The organizational and legal form can be any:

• as a legal entity;
• as an individual entrepreneur.

These medical institutions keep separate records of transactions with funds compulsory insurance.

Rights and obligations of subjects

Any agreement stipulates the rights and obligations of all participants in these legal relations. This insurance contract also contains the basic rights and obligations that are defined by this legislation in Chapter 4. According to Article 16, all insured people have the following rights:

• receiving free medical care throughout the country;
• choose a medical insurance organization with which the insurance contract will be concluded directly;
• select medical organizations from the general register in which medical care will be provided;
• replace the insurance organization with any other one from the register of insurance companies;
• choose a doctor yourself or through a representative;
• has the right to the protection of his personal data;
• protect your legitimate interests and rights;
• demand damages from a medical organization for failure to fulfill its obligations.

The obligations of the insured person include the following:

1. Submit an application to select an insurance company and conclude an insurance contract with it; if you move to another region, re-select an organization in the new entity.
2. Notify the insurance company about changes in personal data.
3. Show proof of insurance to receive free medical services.

Newborn children receive medical care under the mother's policy for the first 30 days, and after this time their legal representatives must obtain for them. From the moment of submitting the application, the insurance company is obliged to issue a policy within 3 days.

Article 17 defines the right of the policyholder to receive information about the procedure for paying insurance premiums and registering him in the register. Responsibilities include the following:

• it is mandatory to register and deregister in accordance with the law;
• pay the established insurance premiums in full on time;
• provide mandatory reporting on contributions paid.

Tax registration is carried out within 30 days from the date of filing the application for registration, and deregistration is carried out within 10 days. To do this, you must submit a corresponding application.

For violation of the established requirements of mandatory registration, administrative liability is provided in the form of a fine of 5,000 rubles.

Also, for violation of other legislative norms, policyholders are subject to fines in other amounts. These amounts are credited to the budget of the Federal Fund.

Medical insurance organizations have rights and obligations that are specified in agreements between them and the insured persons, as well as between them and territorial funds.

Article 20 specifies the rights of medical institutions that actually provide assistance to citizens. These include 2 basic rights:

• receive funds for assistance provided;
• appeal the insurance company's conclusions medical company about the actual amount of work expended.

The responsibilities of this article include the following:

1. Provide free medical care to all insured persons.
2. Keep records of assistance provided.
3. Provide information about the insured persons and the assistance provided to them to the authorities specified by law.
4. Provide reports on your financial activities, as well as publish information on the Internet about the procedure for providing medical care and work schedule.

Also, legislation may establish other obligations and rights of participants in these legal relations.

Financial system

Article 21 defines the main types of income, through which the budget is formed, from which payment for medical care is made. These include:

• collection of fines and penalties from policyholders;
• arrears on tax payments and contributions;
• financing from the federal budget and regional budgets;
• income from temporary placement of funds;
• other permitted sources.

These funds are used to pay for medical care to insured persons. If the services provided exceed the established cost of the basic program, these services may not be paid for by the insurance company.

Payment of insurance premiums

The size and procedure for calculating tariffs are established by the legislation of the Russian Federation. The billing period is considered to be one calendar year. Policyholders must submit quarterly reports on premiums paid.

If the policyholder became obligated to pay premiums not from the beginning of the year, then he must submit information and pay premiums only for the quarter in which he became obligated. The same is considered in case of termination of obligations before the end of the calendar year.

Responsibility for violation of these requirements is provided in the form of arrears, as well as penalties and fines. Penalties are charged for each overdue day in accordance with the established procedure by the policyholder himself. The rate for calculating penalties is one three hundredth of the Bank of Russia rate. Penalties are paid along with the principal amount of debt.

If the policyholder does not independently calculate penalties, then the collection of all penalties is provided for in court.

Compulsory health insurance programs

Article 35 of this legislative act spells out, which forms the basis of the guarantees that citizens can count on in the event of an insured event. It lists the main types of medical care that can be provided to citizens free of charge. This program also includes:

• a list of the insured events themselves;
• methods of payment for medical care;
• tariff calculation;
• criteria for the quality and accessibility of this type of assistance;
• standards for the volume of medical care per insured person.

Types of medical care

The basic program establishes insurance coverage standards based on the standards and procedures for the provision of medical services. This program includes the following types of medical care:

• primary;
• ambulance;
• preventive;
• specialized;
• high-tech.

You can also receive under the compulsory medical insurance policy.

Based on this basic program, territorial programs are established. Article 36 regulates the procedure for drawing up territorial programs, which are part of the basic program, but are established taking into account the characteristics of diseases in a particular subject.

The financial coverage standard for certain illnesses or injuries may exceed the basic program standards if necessary for a particular region.

But the cost of the territorial program cannot exceed the amount of budgetary financial injections from the federal and other budgets.

System of contracts for obtaining a policy

To exercise the rights of the insured person, contracts are concluded in his favor. These are two types of contracts:

• about financial support;
• for the provision and payment of medical care.

Under the first type of contract, a medical insurance organization undertakes to pay for medical care provided to insured citizens by a medical institution.

This agreement must contain the basic mandatory rights and obligations of the insurance company to other participants in these legal relations. It is concluded directly with the policyholder.

The second type of contract is concluded by an insurance company with a medical institution included in the register. This agreement sets out the basic rights and obligations of the medical institution and the insurance company.

Control

For the full implementation of compulsory health insurance, regular monitoring should be carried out over:

The examination verifies the compliance of the actual terms and volumes of services provided with the documents provided. The examination is carried out by a specialist who is a doctor with the required five years of experience and the necessary expert training.

Economic control determines the compliance of information on the volume of assistance provided, based on the documents provided for payment. With the help of quality examination, violations are identified, as well as the timeliness and chosen treatment method.

In case of non-compliance with the services provided, the insurance company may refuse to pay for these services, and certain sanctions may be applied to violators.

Organization of accounting activities

Article 43 of this legislative act obliges to maintain personalized records of all insured citizens. Its main goals are:

• creating the necessary conditions to provide guarantees to citizens;
• determination of medical needs. help;
• creating conditions for high-quality control over the work of the entire health insurance system.

In the process of maintaining personalized records of insured citizens, information is required to be collected, processed and subsequently stored.

Article 45 determines the obligation of an insurance organization to issue an insurance policy to each insured citizen. Upon presentation, he can count on receiving free assistance.

Video: On compulsory social health insurance for citizens of the Russian Federation

Final and transitional provisions

Within the framework of this system, it is envisaged to include additional regional programs financed additionally from funds. The procedure and form of reporting on the implementation of these programs is established by federal authorities.

Providing free high-tech assistance, which is not included in the basic program, is possible with the allocation of additional budget injections into the territorial program.

This legislation applies to all persons included in the list. This law came into force at the beginning of 2011 and is in effect to this day.

Federal Law No. 326-FZ of November 29, 2010 comes into force on January 1, 2011, with the exception of certain provisions applicable since 2012.

• Chapter 2. Powers of the Russian Federation and constituent entities of the Russian Federation in the field of mandatory
  health insurance
• Chapter 3. Subjects of compulsory health insurance and participants
  compulsory health insurance
• Chapter 4. Rights and obligations of insured persons, policyholders, insurers
  
• Chapter 5. Financial support for compulsory health insurance
• Chapter 6. Legal status of the Federal Fund and Territorial Fund
• Chapter 7. Compulsory health insurance programs
• Chapter 8. System of contracts in the field of compulsory health insurance
• Chapter 9. Control of volumes, timing, quality and conditions of provision
  medical assistance under compulsory health insurance
• Chapter 10. Organization of personalized accounting in the field of mandatory
  health insurance

the federal law

On compulsory health insurance in the Russian Federation

Adopted by the State Duma on November 19, 2010
Approved by the Federation Council on November 24, 2010

Article 1. Subject of regulation of this Federal Law

This Federal Law regulates relations arising in connection with the implementation of compulsory health insurance, including determining the legal status of subjects of compulsory health insurance and participants of compulsory health insurance, the grounds for the emergence of their rights and obligations, guarantees for their implementation, relations and responsibilities associated with the payment of insurance contributions for compulsory health insurance of the non-working population.

Article 2. Legal basis of compulsory health insurance

1. The legislation on compulsory health insurance is based on the Constitution of the Russian Federation and consists of the Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens, Federal Law of July 16, 1999 No. 165-FZ “On the Fundamentals of Compulsory Social Insurance”, this Federal Law, other federal laws, laws subjects of the Russian Federation. Relations related to compulsory medical insurance are also regulated by other regulatory legal acts of the Russian Federation and other regulatory legal acts of the constituent entities of the Russian Federation.

2. If an international treaty of the Russian Federation establishes rules other than those provided for by this Federal Law, the rules of the international treaty of the Russian Federation apply.

3. For the purpose of uniform application of this Federal Law, if necessary, appropriate clarifications may be issued in the manner established by the Government of the Russian Federation.

Article 3. Basic concepts used in this Federal Law

For the purposes of this Federal Law, the following basic concepts are used:

1) compulsory health insurance - a type of compulsory social insurance, which is a system of legal, economic and organizational measures created by the state aimed at ensuring, upon the occurrence of an insured event, guarantees of free medical care to the insured person at the expense of compulsory health insurance funds within the territorial compulsory health insurance program and in the cases established by this Federal Law within the framework of the basic compulsory health insurance program;

2) object of compulsory medical insurance - insurance risk associated with the occurrence of an insured event;

3) insurance risk - an expected event, upon the occurrence of which there is a need to incur expenses to pay for the medical care provided to the insured person;

4) insured event - an event that has occurred (illness, injury, other state of health of the insured person, preventive measures), upon the occurrence of which the insured person is provided with insurance coverage under compulsory medical insurance;

5) insurance coverage for compulsory medical insurance (hereinafter referred to as insurance coverage) - fulfillment of obligations to provide the insured person with the necessary medical care upon the occurrence of an insured event and to pay for it to the medical organization;

6) insurance premiums for compulsory medical insurance - mandatory payments that are paid by policyholders, are impersonal in nature and the purpose of which is to ensure the rights of the insured person to receive insurance coverage;

7) insured person - an individual who is covered by compulsory health insurance in accordance with this Federal Law;

8) the basic program of compulsory health insurance - an integral part of the program of state guarantees of free provision of medical care to citizens, which determines the rights of insured persons to receive free medical care at the expense of compulsory health insurance throughout the Russian Federation and establishes uniform requirements for territorial compulsory health insurance programs;

9) territorial compulsory health insurance program - an integral part of the territorial program of state guarantees of free medical care to citizens, which determines the rights of insured persons to free medical care on the territory of a constituent entity of the Russian Federation and meets the uniform requirements of the basic compulsory health insurance program.

Article 4. Basic principles of compulsory health insurance

The basic principles of compulsory health insurance are:

1) ensuring, at the expense of compulsory health insurance funds, guarantees of free provision of medical care to the insured person upon the occurrence of an insured event within the framework of the territorial compulsory health insurance program and the basic compulsory health insurance program (hereinafter also referred to as the compulsory health insurance program);

2) the stability of the financial system of compulsory medical insurance, ensured on the basis of the equivalence of insurance coverage with compulsory medical insurance;

3) mandatory payment by policyholders of insurance premiums for compulsory medical insurance in the amounts established by federal laws;

4) state guarantee of observance of the rights of insured persons to fulfill obligations under compulsory health insurance within the framework of the basic compulsory health insurance program, regardless of the financial situation of the insurer;

5) creating conditions to ensure accessibility and quality of medical care provided within the framework of compulsory health insurance programs;

6) parity of representation of subjects of compulsory health insurance and participants of compulsory health insurance in the governing bodies of compulsory health insurance.

Article 5. Powers of the Russian Federation in the field of compulsory health insurance

The powers of the Russian Federation in the field of compulsory health insurance include:

1) development and implementation of state policy in the field of compulsory health insurance;

2) organization of compulsory medical insurance on the territory of the Russian Federation;

3) establishing the circle of persons subject to compulsory health insurance;

4) establishing tariffs for insurance premiums for compulsory medical insurance and the procedure for collecting insurance premiums for compulsory medical insurance;

5) approval of the basic compulsory health insurance program and uniform requirements for territorial compulsory health insurance programs;

6) establishing the procedure for the distribution, provision and expenditure of subventions from the budget of the Federal Compulsory Health Insurance Fund to the budgets of territorial compulsory health insurance funds;

7) establishing the liability of subjects of compulsory health insurance and participants of compulsory health insurance for violation of the legislation on compulsory health insurance;

8) organization of management of compulsory health insurance funds;

9) definition general principles organizations information systems and information interaction in the field of compulsory medical insurance, maintaining personalized records of information about insured persons and personalized records of information about medical care provided to insured persons;

10) establishment of a system for protecting the rights of insured persons in the field of compulsory health insurance.

Article 6. The powers of the Russian Federation in the field of compulsory medical insurance, transferred for implementation to state authorities of the constituent entities of the Russian Federation

1. The powers of the Russian Federation in the field of compulsory health insurance, transferred for implementation to state authorities of the constituent entities of the Russian Federation, include the organization of compulsory medical insurance in the territories of the constituent entities of the Russian Federation in accordance with the requirements established by this Federal Law, including:

1) approval of territorial compulsory medical insurance programs that meet the uniform requirements of the basic compulsory medical insurance program, and the implementation of the basic compulsory medical insurance program in the territories of the constituent entities of the Russian Federation within the limits and at the expense of subventions provided from the budget of the Federal Compulsory Medical Insurance Fund to the budgets of territorial compulsory medical insurance funds ;

2) approval of differentiated per capita standards for financial support of compulsory medical insurance (hereinafter referred to as differentiated per capita standards) in the territories of the constituent entities of the Russian Federation in accordance with the rules of compulsory health insurance approved by the federal executive body authorized by the Government of the Russian Federation (hereinafter referred to as the rules of compulsory health insurance), for medical insurance organizations;

3) registration and deregistration of insurers for non-working citizens;

4) administration of budget revenues of the Federal Compulsory Medical Insurance Fund, received from the payment of insurance premiums for compulsory medical insurance of the non-working population in the territories of the constituent entities of the Russian Federation;

5) control over the use of compulsory health insurance funds in the territories of the constituent entities of the Russian Federation, including carrying out inspections and audits;

6) making payments for medical care provided to insured persons outside the constituent entity of the Russian Federation on the territory of which a compulsory health insurance policy (hereinafter also referred to as a medical insurance policy) was issued, in accordance with the uniform requirements of the basic compulsory health insurance program;

7) ensuring the rights of citizens in the field of compulsory health insurance in the territories of the constituent entities of the Russian Federation;

8) maintaining personalized records of information about insured persons in the form of a regional segment of the unified register of insured persons, as well as personalized records of information about medical care provided to insured persons;

9) maintaining reports in the field of compulsory health insurance.

2. Financial support for the expenditure obligations of the constituent entities of the Russian Federation arising in the exercise of powers delegated in accordance with Part 1 of this article is carried out at the expense of subventions provided from the budget of the Federal Compulsory Medical Insurance Fund to the budgets of territorial compulsory medical insurance funds.

3. The highest official of a constituent entity of the Russian Federation (the head of the highest executive body of state power of a constituent entity of the Russian Federation), when exercising the powers delegated in accordance with Part 1 of this article:

1) organizes activities for the implementation of delegated powers in accordance with federal laws and other regulatory legal acts of the Russian Federation;

2) provides in the prescribed manner:

a) making a decision to create, if there is no non-profit organization on the territory of a constituent entity of the Russian Federation, a territorial fund for compulsory health insurance (hereinafter referred to as the territorial fund);

b) approval of the management structure of the territorial fund in agreement with the Federal Compulsory Health Insurance Fund (hereinafter referred to as the Federal Fund);

c) appointment and dismissal of the head of the territorial fund in agreement with the Federal Fund;

3) ensures, in the prescribed manner, timely submission to the federal executive body authorized by the Government of the Russian Federation (hereinafter referred to as the authorized federal executive body) and the Federal Fund:

a) reporting on the implementation of delegated powers, on the expenditure of provided subventions, on the achievement of target forecast indicators (if such indicators are established) in the established form;

b) normative legal acts adopted by government bodies of constituent entities of the Russian Federation to exercise delegated powers, within three days after the day of their adoption;

c) information (including databases) necessary for maintaining a unified register of insured persons;

d) information on forecast indicators for the implementation of delegated powers in the prescribed form;

e) other information provided for by this Federal Law and (or) other regulatory legal acts of the Russian Federation adopted in accordance with it.

4. Control over the use of compulsory health insurance funds ensuring the implementation of the powers delegated in accordance with Part 1 of this article is carried out by the Federal Fund, the federal executive body exercising control and supervision functions in the financial and budgetary sphere, and the Accounts Chamber of the Russian Federation.

Article 7. Rights and obligations of the authorized federal executive body and the Federal Fund for the implementation of the delegated powers of the Russian Federation in the field of compulsory health insurance by state authorities of the constituent entities of the Russian Federation

1. The authorized federal executive body exercises the following rights and responsibilities for the exercise of powers delegated in accordance with Part 1 of Article 6 of this Federal Law:

1) issues normative legal acts and guidelines on the implementation by government bodies of the constituent entities of the Russian Federation of delegated powers;

2) exercises supervision over the legal regulation carried out by government bodies of the constituent entities of the Russian Federation on issues of delegated powers, with the right to send binding orders to repeal normative legal acts or to make changes to them;

3) exercises control and supervision over the completeness and quality of the implementation by public authorities of the constituent entities of the Russian Federation of delegated powers with the right to conduct inspections and issue mandatory instructions:

a) on eliminating identified violations;

b) on bringing to responsibility established by the legislation of the Russian Federation officials of government bodies of constituent entities of the Russian Federation and territorial funds;

4) prepares and sends to the highest official of a constituent entity of the Russian Federation (the head of the highest executive body of state power of a constituent entity of the Russian Federation) proposals for the removal from office of officials of public authorities of constituent entities of the Russian Federation and territorial funds;

5) has the right to set target forecast indicators for the implementation of delegated powers;

6) approves the rules of compulsory medical insurance, including the methodology for calculating tariffs for payment of medical care and the procedure for paying for medical care under compulsory medical insurance;

7) determines the procedure for maintaining personalized records in the field of compulsory health insurance;

8) prepares and sends to the Government of the Russian Federation proposals for the withdrawal of relevant powers from public authorities of the constituent entities of the Russian Federation in the manner established by the Government of the Russian Federation;

9) establishes the procedure for reimbursement of subventions provided from the budget of the Federal Fund to the budgets of territorial funds for the exercise of relevant powers;

10) exercises other powers established by this Federal Law and other federal laws.

2. The Federal Fund exercises the following rights and obligations to exercise powers delegated in accordance with Part 1 of Article 6 of this Federal Law:

1) issues normative legal acts and guidelines for the implementation of delegated powers by territorial funds;

2) provides subventions from the budget of the Federal Fund to the budgets of territorial funds for financial support for the implementation of powers transferred in accordance with Part 1 of Article 6 of this Federal Law;

3) exercises control over the payment of insurance premiums for compulsory medical insurance of the non-working population, including checking the activities of territorial funds to perform the functions of administrator of the Federal Fund budget revenues received from the payment of insurance premiums for compulsory medical insurance of the non-working population, has the right to charge and collect from insurers for non-working citizens, arrears on the specified insurance premiums, penalties and fines;

4) establishes reporting forms in the field of compulsory health insurance and the procedure for its maintenance;

5) establishes the procedure for monitoring the volumes, timing, quality and conditions of providing medical care under compulsory health insurance to insured persons (hereinafter also referred to as control of the volumes, timing, quality and conditions of providing medical care);

6) exercises control over compliance with the legislation on compulsory health insurance and the use of compulsory health insurance funds, including conducting inspections and audits;

7) exercises control over the functioning of information systems and the procedure for information interaction in the field of compulsory health insurance;

8) coordinates the structure of territorial funds, the appointment and dismissal of heads of territorial funds, as well as standards of expenses for ensuring that territorial funds perform their functions.

Article 8. Powers of state authorities of constituent entities of the Russian Federation in the field of compulsory health insurance

The powers of state authorities of the constituent entities of the Russian Federation in the field of compulsory health insurance include:

1) payment of insurance premiums for compulsory medical insurance of the non-working population;

2) establishment in territorial compulsory medical insurance programs of additional volumes of insurance coverage for insured events established by the basic compulsory medical insurance program, as well as additional types and conditions for the provision of medical care not established by the basic compulsory medical insurance program;

3) financial support and implementation of territorial compulsory health insurance programs in an amount exceeding the amount of subventions provided from the budget of the Federal Fund to the budgets of territorial funds;

4) approval of budgets of territorial funds and reports on their execution.

Article 9. Subjects of compulsory health insurance and participants of compulsory health insurance

1. The subjects of compulsory health insurance are:

1. insured persons;
2. policyholders;
3. Federal Fund.

2. Participants in compulsory health insurance are:

1. territorial funds;
2. medical insurance organizations;
3. medical organizations.

Article 10. Insured persons

Insured persons are citizens of the Russian Federation, foreign citizens permanently or temporarily residing in the Russian Federation, stateless persons (with the exception of highly qualified specialists and members of their families in accordance with Federal Law of July 25, 2002 No. 115-FZ “On the legal status of foreign citizens in the Russian Federation” ), as well as persons entitled to medical care in accordance with the Federal Law “On Refugees”:

1) working under an employment contract or civil law contract, the subject of which is the performance of work, provision of services, as well as under an author’s order agreement or a license agreement;

2) self-sufficient workers ( individual entrepreneurs notaries and lawyers engaged in private practice);

3) who are members of peasant (farm) enterprises;

4) who are members of family (tribal) communities of indigenous peoples of the North, Siberia and the Far East of the Russian Federation, living in the regions of the North, Siberia and the Far East of the Russian Federation, engaged in traditional economic sectors;

5) unemployed citizens:

a) children from the day of birth until they reach the age of 18;

b) non-working pensioners, regardless of the basis for granting a pension;

c) citizens studying full-time in educational institutions primary vocational, secondary vocational and higher vocational education;

d) unemployed citizens registered in accordance with employment legislation;

e) one of the parents or guardian caring for the child until he reaches the age of three;

f) able-bodied citizens caring for disabled children, group I disabled people, and persons over 80 years of age;

g) other citizens not working under an employment contract and not specified in subparagraphs “a” - “e” of this paragraph, with the exception of military personnel and persons equivalent to them in the organization of medical care.

Article 11. Policyholders

1. Insurers for working citizens specified in paragraphs 1 - 4 of Article 10 of this Federal Law are:

1) persons making payments and other remuneration to individuals:

a) organizations;

b) individual entrepreneurs;

c) individuals who are not recognized as individual entrepreneurs;

2) individual entrepreneurs, notaries and lawyers engaged in private practice.

2. Insurers for non-working citizens specified in paragraph 5 of Article 10 of this Federal Law are the executive authorities of the constituent entities of the Russian Federation, authorized by the highest executive bodies of state power of the constituent entities of the Russian Federation. These insurers are payers of insurance premiums for compulsory medical insurance of the non-working population.

Article 12. Insurer

1. The insurer for compulsory medical insurance is the Federal Fund as part of the implementation of the basic compulsory medical insurance program.

2. The Federal Fund is a non-profit organization created by the Russian Federation in accordance with this Federal Law to implement state policy in the field of compulsory health insurance.

Article 13. Territorial funds

1. Territorial funds are non-profit organizations created by constituent entities of the Russian Federation in accordance with this Federal Law to implement state policy in the field of compulsory health insurance in the territories of constituent entities of the Russian Federation.

2. Territorial funds exercise certain powers of the insurer regarding the implementation of territorial compulsory health insurance programs within the framework of the basic compulsory health insurance program in accordance with this Federal Law.

3. Territorial funds exercise the powers of the insurer in terms of additional volumes of insurance coverage established by territorial compulsory medical insurance programs for insured events established by the basic compulsory medical insurance program, as well as additional grounds, lists of insured events, types and conditions for the provision of medical care in addition to those established by the basic compulsory health insurance program.

4. To exercise the powers established by this Federal Law, territorial funds may create branches and representative offices.

Article 14. Medical insurance organization operating in the field of compulsory medical insurance

1. An insurance medical organization operating in the field of compulsory medical insurance (hereinafter referred to as an insurance medical organization) is an insurance organization that has a license issued by the federal executive body exercising control and supervision functions in the field of insurance activities. The specifics of licensing the activities of medical insurance organizations are determined by the Government of the Russian Federation. The medical insurance organization exercises certain powers of the insurer in accordance with this Federal Law and the agreement on the financial support of compulsory medical insurance concluded between the territorial fund and the medical insurance organization (hereinafter referred to as the agreement on the financial support of compulsory medical insurance).

2. The founders (participants, shareholders) and management bodies of an insurance medical organization may not include employees of federal executive authorities in the field of health care, executive authorities of constituent entities of the Russian Federation in the field of health care, local government bodies authorized to carry out management in the field of health care, the Federal fund and territorial funds, medical organizations providing medical care under compulsory health insurance.

3. Medical insurance organizations do not have the right to carry out activities other than compulsory and voluntary medical insurance.

4. Medical insurance organizations maintain separate records of transactions with compulsory medical insurance funds and voluntary medical insurance funds, taking into account the specifics established by the regulatory legal acts of the federal executive body exercising the functions of legal regulation in the field of insurance activities, and the Federal Fund.

5. Medical insurance organizations maintain separate records of their own funds and funds of compulsory health insurance intended to pay for medical care.

6. Funds intended to pay for medical care and received by a medical insurance organization are targeted financing funds (hereinafter referred to as targeted funds).

7. Medical insurance organizations carry out their activities in the field of compulsory medical insurance on the basis of an agreement on financial support for compulsory medical insurance, an agreement for the provision and payment of medical care under compulsory medical insurance, concluded between a medical insurance organization and a medical organization (hereinafter referred to as the agreement for the provision and payment for medical care under compulsory health insurance).

8. Medical insurance organizations are liable for obligations arising from contracts concluded in the field of compulsory medical insurance in accordance with the legislation of the Russian Federation and the terms of these contracts.

9. Medical insurance organizations, in accordance with the requirements established by the rules of compulsory medical insurance, post on their official websites on the Internet, publish in the media or bring to the attention of insured persons in other ways provided for by the legislation of the Russian Federation information about their activities, composition founders (participants, shareholders), financial results activities, work experience, the number of insured persons, medical organizations operating in the field of compulsory health insurance on the territory of a constituent entity of the Russian Federation, types, quality and conditions for the provision of medical care, violations identified based on requests from insured persons in the provision of medical care, the rights of citizens in the field of compulsory health insurance, including the right to choose or replace a medical insurance organization, medical organization, the procedure for obtaining a compulsory health insurance policy, as well as the responsibilities of insured persons in accordance with this Federal Law.

10. A medical insurance organization is included in the register of medical insurance organizations operating in the field of compulsory medical insurance (hereinafter also referred to as the register of medical insurance organizations), on the basis of a notification sent by it to the territorial fund before September 1 of the year preceding the year in which the medical insurance The organization intends to operate in the field of compulsory health insurance. The procedure for maintaining, the form and list of information in the register of medical insurance organizations are established by the rules of compulsory medical insurance.

11. If in the territories of the constituent entities of the Russian Federation there are no medical insurance organizations included in the register of medical insurance organizations, their powers are exercised by the territorial fund until the day the activities of the medical insurance organizations included in the register of medical insurance organizations begin.

Article 15. Medical organizations in the field of compulsory health insurance

1. For the purposes of this Federal Law, medical organizations in the field of compulsory health insurance (hereinafter referred to as medical organizations) include those that have the right to carry out medical activities and included in the register of medical organizations operating in the field of compulsory health insurance (hereinafter also referred to as the register of medical organizations) , in accordance with this Federal Law:

1) an organization of any organizational and legal form provided for by the legislation of the Russian Federation;

2) individual entrepreneurs engaged in private medical practice.

2. A medical organization is included in the register of medical organizations on the basis of a notification sent by it to the territorial fund before September 1 of the year preceding the year in which the medical organization intends to carry out activities in the field of compulsory health insurance. The territorial fund does not have the right to refuse to include a medical organization in the register of medical organizations. The commission for the development of a territorial compulsory health insurance program in a constituent entity of the Russian Federation may establish other deadlines for the submission of notification by newly created medical organizations.

3. The register of medical organizations contains the names, addresses of medical organizations and a list of services provided by these medical organizations within the framework of the territorial compulsory health insurance program. The procedure for maintaining, the form and list of information in the register of medical organizations are established by the rules of compulsory health insurance. The register of medical organizations is maintained by the territorial fund, is posted without fail on its official website on the Internet and may be additionally published in other ways.

4. Medical organizations included in the register of medical organizations do not have the right, during the year in which they operate in the field of compulsory health insurance, to withdraw from the number of medical organizations operating in the field of compulsory health insurance, with the exception of cases of liquidation of the medical organization, loss of the right to carry out medical activities, bankruptcy or other cases provided for by the legislation of the Russian Federation.

5. A medical organization carries out its activities in the field of compulsory health insurance on the basis of an agreement for the provision and payment of medical care under compulsory health insurance and does not have the right to refuse to insured persons the provision of medical care in accordance with the territorial program of compulsory health insurance.

6. Medical organizations maintain separate records of transactions with compulsory health insurance funds.

7. Medical organizations created in accordance with the legislation of the Russian Federation and located outside the territory of the Russian Federation have the right to provide types of medical care to insured persons established by the basic program of compulsory medical insurance, at the expense of compulsory medical insurance in the manner established by the rules of compulsory medical insurance.

Chapter 4. Rights and obligations of insured persons, policyholders, insurers
medical organizations and medical organizations

Article 16. Rights and obligations of insured persons

1. Insured persons have the right to:

1) free provision of medical care to them by medical organizations upon the occurrence of an insured event:

a) throughout the territory of the Russian Federation to the extent established by the basic compulsory health insurance program;

b) on the territory of the constituent entity of the Russian Federation in which the compulsory health insurance policy was issued, to the extent established by the territorial compulsory health insurance program;

2) choosing a medical insurance organization by submitting an application in the manner established by the rules of compulsory health insurance;

3) replacement of the medical insurance organization in which the citizen was previously insured, once during the calendar year no later than November 1, or more often in the event of a change of residence or termination of the agreement on financial support for compulsory health insurance in the manner established by the rules of compulsory health insurance, by submitting an application to the newly selected medical insurance organization;

4) selection of a medical organization from medical organizations participating in the implementation of the territorial compulsory health insurance program in accordance with the legislation of the Russian Federation;

5) choosing a doctor by submitting an application personally or through your representative addressed to the head of the medical organization in accordance with the legislation of the Russian Federation;

6) obtaining from the territorial fund, medical insurance organization and medical organizations reliable information about the types, quality and conditions for the provision of medical care;

7) protection of personal data necessary for maintaining personalized records in the field of compulsory health insurance;

8) compensation by the medical insurance organization for damage caused in connection with its failure to fulfill or improper fulfillment of its obligations to organize the provision of medical care, in accordance with the legislation of the Russian Federation;

9) compensation by a medical organization for damage caused in connection with its failure to fulfill or improper fulfillment of its responsibilities for organizing and providing medical care, in accordance with the legislation of the Russian Federation;

10) protection of rights and legitimate interests in the field of compulsory health insurance.

2. Insured persons are obliged:

1) present a compulsory medical insurance policy when seeking medical care, with the exception of cases of emergency medical care;

2) submit to the medical insurance organization personally or through your representative an application for choosing a medical insurance organization in accordance with the rules of compulsory medical insurance;

3) notify the medical insurance organization of changes in last name, first name, patronymic, place of residence within one month from the day these changes occurred;

4) select a medical insurance organization at a new place of residence within one month in the event of a change of residence and the absence of a medical insurance organization in which the citizen was previously insured.

3. Compulsory medical insurance of children from the day of birth to the day of state registration of birth is carried out by a medical insurance organization in which their mothers or other legal representatives are insured. After the day of state registration of the child’s birth and until he reaches the age of majority or after he acquires full legal capacity and until he reaches the age of majority, compulsory health insurance is carried out by an insurance medical organization chosen by one of his parents or other legal representative.

4. The choice or replacement of an insurance medical organization is carried out by the insured person who has reached the age of majority or has acquired full legal capacity before reaching the age of majority (for a child before reaching the age of majority or after he has acquired full legal capacity before reaching the age of majority - his parents or other legal representatives), by contacting an insurance medical organization from among those included in the register of insurance medical organizations, which is posted without fail by the territorial fund on its official website on the Internet and can be additionally published in other ways.

5. To select or replace a medical insurance organization, the insured person personally or through his representative applies to the medical insurance organization of his choice with an application to select (replace) this medical insurance organization. Based on the specified application, the insured person or his representative is issued a compulsory health insurance policy by the insurance medical organization in the manner established by the rules of compulsory health insurance. If the insured person has not submitted an application to select (replace) a medical insurance organization, such person is considered insured by the medical insurance organization with which he was previously insured, except for the cases provided for in paragraph 4 of part 2 of this article.

6. Information about citizens who have not applied to a medical insurance organization for the issuance of compulsory medical insurance policies is sent monthly by the 10th day by the territorial fund to medical insurance organizations operating in the field of compulsory medical insurance in a constituent entity of the Russian Federation, in proportion to the number of insured persons in each of them to conclude agreements on financial support for compulsory health insurance. The ratio of working citizens and non-working citizens who have not applied to a medical insurance organization, which is reflected in the information sent to medical insurance organizations, must be equal.

7. Medical insurance organizations specified in Part 6 of this article:

1) within three working days from the date of receipt of information from the territorial fund, the insured person is informed in writing about the fact of insurance and the need to obtain a compulsory health insurance policy;

2) ensure the issuance of a compulsory health insurance policy to the insured person in the manner established by Article 46 of this Federal Law;

3) provide the insured person with information about his rights and obligations.

Article 17. Rights and obligations of policyholders

1. The policyholder has the right to receive information from the Federal Fund and territorial funds related to the registration of policyholders and their payment of insurance premiums for compulsory health insurance.

2. The policyholder is obliged:

1) register and deregister for the purposes of compulsory health insurance;

2) make timely and full payment of insurance premiums for compulsory health insurance.

3. Insurers specified in Part 2 of Article 11 of this Federal Law are required to submit to the territorial funds calculations of accrued and paid insurance premiums for compulsory medical insurance of the non-working population in the manner established by Part 11 of Article 24 of this Federal Law.

4. Registration and deregistration of policyholders specified in Part 1 of Article 11 of this Federal Law are carried out in the territorial bodies of the Pension Fund of the Russian Federation. Control over the registration and deregistration of these insurers is carried out by the territorial bodies of the Pension Fund of the Russian Federation, which submit the relevant data to the territorial funds in the manner determined by the agreement on information exchange between the Pension Fund of the Russian Federation and the Federal Fund.

5. Registration and deregistration of insurers specified in Part 2 of Article 11 of this Federal Law are carried out by territorial funds in the manner established by the authorized federal executive body, in this case:

1) registration as an insured is carried out on the basis of an application for registration submitted no later than 30 working days from the date of entry into force of the decision of the highest executive body of state power of a constituent entity of the Russian Federation on conferring powers on the insured (hereinafter referred to as the conferment of powers);

2) deregistration of the insured is carried out on the basis of an application for deregistration as an insured, submitted within 10 working days from the date of entry into force of the decision of the highest executive body of state power of a constituent entity of the Russian Federation on termination of the powers of the insured (hereinafter referred to as termination of powers).

6. Registration and deregistration of policyholders is carried out on the basis of documents submitted by them on paper or electronic media.

7. The specifics of registering certain categories of policyholders and their payment of insurance premiums for compulsory health insurance are established by the Government of the Russian Federation.

Article 18. Liability for violation of registration requirements and deregistration of insurers for non-working citizens

1. Violation by the policyholders specified in Part 2 of Article 11 of this Federal Law of the deadline for filing an application for registration or deregistration with territorial funds entails a fine of five thousand rubles.

2. Refusal to submit or failure to submit within the prescribed period by insurers for non-working citizens to territorial funds documents or copies of documents provided for by this Federal Law and (or) other regulatory legal acts adopted in accordance with this Federal Law shall entail the imposition of a fine in the amount 50 rubles for each document not submitted.

3. If violations specified in parts 1 and (or) 2 of this article are detected, officials of the Federal Fund or territorial funds draw up reports of violations of the legislation on compulsory health insurance in the form approved by the Federal Fund.

4. Consideration of cases of violation of the legislation on compulsory health insurance and the imposition of fines in terms of registration and deregistration of insurers for non-working citizens are carried out by officials of the Federal Fund or territorial funds in the manner established by the authorized federal executive body.

5. The list of officials of the Federal Fund and territorial funds authorized to draw up acts on violations of the legislation on compulsory health insurance, consider cases of such violations and impose fines in accordance with parts 3 and 4 of this article is approved by the Federal Fund.

6. Fines assessed in accordance with this article are credited to the budget of the Federal Fund.

Article 19. Rights and obligations of medical insurance organizations

The rights and obligations of medical insurance organizations are determined in accordance with the contracts provided for in Articles 38 and 39 of this Federal Law.

Article 20. Rights and obligations of medical organizations

1. Medical organizations have the right:

1) receive funds for medical care provided on the basis of concluded contracts for the provision and payment of medical care under compulsory medical insurance in accordance with the established tariffs for payment for medical care under compulsory medical insurance (hereinafter also referred to as tariffs for payment for medical care) and in other cases, provided for by this Federal Law;

2) appeal the conclusions of the medical insurance organization and the territorial fund on the assessment of the volume, timing, quality and conditions of providing medical care in accordance with Article 42 of this Federal Law.

2. Medical organizations are obliged to:

1) provide free medical care to insured persons within the framework of compulsory health insurance programs;

2) keep, in accordance with this Federal Law, personalized records of information about medical care provided to insured persons;

3) provide medical insurance organizations and the territorial fund with information about the insured person and the medical care provided to him, necessary to monitor the volume, timing, quality and conditions of medical care;

4) provide reports on activities in the field of compulsory health insurance in the manner and in the forms established by the Federal Fund;

5) use compulsory medical insurance funds received for medical care provided in accordance with compulsory medical insurance programs;

6) post on its official website on the Internet information about operating hours and types of medical care provided;

7) provide insured persons, medical insurance organizations and the territorial fund with information about operating hours, types of medical care provided, indicators of accessibility and quality of medical care;

8) perform other duties in accordance with this Federal Law.

Medical support for Russian citizens is carried out according to. The blue-gray form, known to everyone, was included in the list of obligatory documents for Russians, and the doctor’s request to present it no longer confuses patients.

However, as often happens with legislative requirements, in the philistine opinion the presence of a document is perceived as nothing more than a tribute to the bureaucratic machine. Therefore, we will understand the basic postulates of the legislation on the organization of medical care for the population. Free and accessible, built on the latest scientific thought and technical support.

Legislative framework

In full force insurance system medical provision for Russians, and in some cases, representatives of other states, began operating in Russia in January 2011, when the “Law on Compulsory Health Insurance in the Russian Federation” (No. 326-FZ dated November 29, 2010) came into force.

The Compulsory Medical Insurance Law regulated a new approach to organizing free medical care for the population. Medicine has finally become insurance, aimed at ensuring the social rights of citizens.

The policy guarantees a person the provision of treatment and preventive measures in the event of an insured event at the expense of funds accumulated by the insurer. The formation of a financial reserve takes Russian medicine to a qualitatively different level and allows clinics to be re-equipped to world standards.

Parties to the agreement

Participants in health insurance The following parties speak out (chapter 3):

Public health insurance cannot be implemented without the professional input of representatives whose field of activity requires licensing.

Insurance medical organizations. They are financial operators of the health insurance regime: they accumulate financial flows from incoming contributions and their own funds, and distribute them for the provision of medical care.

These entities are responsible for financial obligations arising from compulsory medical insurance agreements. In addition to compulsory licensing (license from the Ministry of Finance), the legitimacy of the organization is confirmed by inclusion in the state register of CMOs.

Medical organizations in the field of compulsory medical insurance. These are medical institutions that directly provide medical and preventive services to the population through the insurance system. In accordance with Art. 15 Federal Law 326, clinics of all organizational and legal types and private practitioners are allowed to participate in compulsory medical insurance programs. All of them are subject to inclusion in the registers of structures providing services under compulsory medical insurance plans.

Rights and obligations

Parties to compulsory medical insurance, which perform key tasks:

But the responsibilities of policy owners are extremely simple: receive a document and present it if necessary. Insured citizens can choose a clinic, doctors and insurance organization, guided by personal preferences and private life circumstances. And accredited clinics do not have the right to refuse free assistance to the bearer of a supporting document.

How is the insurance fund organized and financed?

Federal compulsory health insurance funds (FFOMS) are organized by the state.

The bodies structurally act as insurers, but are not licensed to conduct insurance business. And here’s why: according to the legal status, compulsory medical insurance funds are classified as part of the state social branch. Management is carried out collectively: the government of the Russian Federation approves the composition of the board of 11 people, headed by the chairman.

Territorial funds Medical insurance companies (TFOMS) are not insurers by status, but they are participants in the compulsory insurance system. Management is carried out by the director of the Federal Compulsory Compulsory Medical Insurance Fund, appointed by the executive authorities of the constituent entities in agreement with the Federal Compulsory Compulsory Medical Insurance Fund.

Program funding

The lion's share of financial flows for health insurance is formed through contributions from insurers of various levels. Business units, regardless of the form of activity, transfer these payments as part of the Unified Social Tax (UST).

Basic moments assessment of contributions:

Violation of the procedure for calculating and paying the unified social tax entails tax liability of policyholders in accordance with the norms of the Tax Code of the Russian Federation.

In addition to insurance proceeds, the following companies participate in providing compulsory medical insurance programs: funds from municipal, regional and federal budgets.

Work organization

In health insurance, clinics saw an opportunity to receive additional money from the state for their development: expanding the list of services, re-equipment. But the money is not allocated thoughtlessly, but according to a special scheme that shows the effectiveness of the medical institution. TFOMS finance professional participants of MS programs in strict dependence on the number of insured persons and established standards in the region.

Wherein development parameters are analyzed funds already transferred. If “saved” money is discovered, the security for the next period will be reduced by exactly the amount of the savings. Legal relations, opportunities and responsibilities of medical institutions and territorial funds coordinated by a set of rules at the regional level, financing agreements.

When the owner compulsory medical insurance policy falls ill, undergoes a preventive program, goes to hospital, etc., experts from insurance medical organizations will not leave the matter to the medicine alone. The methods and quality of state-funded assistance are strictly controlled.

Last changes

Like all systemic innovations, compulsory health insurance was tested during the first years of its operation with periodic amendments.

In 2014-2015, high-tech medical care (HTMC) entered the compulsory insurance system. Then the insurance system covered more than 450 of the most popular treatment methods. Two years later, the list expanded to 512 items, and an algorithm was developed for providing medical benefits that are not included in the basic compulsory medical insurance system.

Since July 2016 in test mode the institute of insurance representatives has started– “trustees” in health matters. These employees help citizens navigate the available compulsory medical insurance opportunities, provide legal support, and monitor the quality of medical care.

About the principles of operation of the compulsory medical insurance system, see the following video: